Behavioral interventions for tobacco use in HIV-infected smokers: A meta-analysis

Context: Smoking is responsible for increased morbidity and mortality in HIV-infected smokers. Objective: To assess the efficacy of behavioral interventions for smoking cessation among HIV-infected smokers compared with the standard care. Data sources: PubMed, Cochrane, CINHAL, PsychINFO, and Google Scholar were searched for randomized controlled trials published in English. Study selection: Eligibility criteria were randomized controlled trials with targeted behavioral interventions compared with standard of care (or enhanced standard of care) aimed at promoting abstinence in HIV-infected smokers. A total of 17,384 articles were found and 17,371 were excluded; 13 full text articles were obtained and reviewed, and 8 met the eligibility criteria (Κ 0.94). Data extraction: The primary outcome was expired carbon monoxide-verified 7-day point prevalence abstinence rates. Adequate sequence generation and freedom from incomplete or selective outcome reporting was used to assess study quality. Results: A total of 1822 subjects from 8 studies yielded a statistically significant effect of behavioral interventions in increasing abstinence in HIV-infected smokers with a moderate effect size (relative risk: 1.51; 95% confidence interval: 1.17 to 1.95). Those studies with interventions of 8 sessions or more had a large effect size for abstinence (relative risk: 2.88; 95% confidence interval: 1.89 to 4.61). When stratified by the number of sessions, there was no heterogeneity. Conclusions: Targeted behavioral smoking cessation interventions are efficacious. Interventions consisting of 8 sessions or more had the greatest treatment efficacy.